It's been quite a start to the year, even without Brexit. There's been more than the usual number of announcements, the closest to home being from the Nursing and Midwifery Council (NMC) (2019) on the imminent arrival of registered nursing associates (RNAs). A warmest welcome! Having spent much of the 1990s waving goodbye to the state enrolled nurse (SEN) in the blind pursuit of graduate status for nurses, this baby was thrown out with the bathwater. Hopefully, we've learnt the importance of having a path that leads to registered nurse (RN) status. I am but one who would have started my career today as an RNA.
January also saw the launch of The NHS Long Term Plan (NHS England, 2019), a significant moment, in that it officially abandons the policy of competition in the English NHS. As with nursing, it brings us back around the block, with a focus on integration within health and across the blurred lines of social care. It continues the trend of shifting resources from hospital to community started 20 years ago in mental health with the National Service Framework. Having been involved in policy development and implementation work over the past 20 years here and abroad, the one critical factor has been (the lack of) persistence, seeing through a strategy and working incrementally with feedback to understand, refine and build.
Details have also emerged about the investment in primary care with a 5-year GP contract. This includes many promises to make primary care careers more attractive for nurses, as well as creating truly multidisciplinary teams.
A milestone for nurses preparing for the future NHS also came in January: congratulations to Sheffield Hallam University on the approval of its RN programme, validated to the new NMC standards framework. As with the NHS plan (2019), only time will tell whether the ambitions of our profession will be fulfilled through opportunities to learn and evolve as new knowledge about health and health care emerges. Of course, we have an important part in expanding that knowledge, with colleagues actively engaging and influencing bodies such as the National Institute of Health Research.
And yet… while we should recognise that the Government is sounding as though it is reversing its austerity policy that has decimated social care and squeezed health services, let's not get carried away. This month, the National Audit Office (NAO) (2019) reported that none of the adult screening programmes met its ‘standard’ coverage target in 2017–18, and of particular concern are the problems underlying cervical and breast screening services.
And, while we can bemoan the current state of our NHS, the decimation of our social care system and the welfare cuts are of no less concern. Poverty and social deprivation are killers and austerity has hit our more disadvantaged communities most. The biggest cloud on the horizon is Brexit and the fear of its negative impact on our national income and public finances. The consequences of a bad Brexit will ricochet down through society to harm the most vulnerable.
Social justice and an equitable approach are the benchmarks of our NHS and welfare system but here we are, in midwinter, with thousands on the streets. The Ministry of Housing, Communities and Local Government (2019) tells us that rough sleeping has decreased 2% in the past year. Does that mean it will be sorted in 50 years? The charity Crisis (2019) juxtaposes this government figure against an increase of 165% since 2010. Simply talking about the shocking health morbidity and mortality rates does not capture the experience of real-world suffering.
If we are at a turning point, and January has offered much to be optimistic about, let us begin by acknowledging where we are as a society.